Among the few policy initiatives in a mostly retroflective State of the State Address yesterday, Governor Dennis Daugaard embraced a cranky Trump proposal to impose a work requirement on some Medicaid recipients.
Most South Dakotans receiving Medicaid can’t be forced to work:
About 120,000 South Dakotans—maybe 13% of our population—receive Medicaid. About 68% of those recipients are children (almost 4 in 10 South Dakota kids). Nearly 20% of our Medicaid recipients are aged, blind, or disabled. 1% are pregnant women. Less than 11% are low-income parents who could—or in pushy conservative parlance, should—be working.
Governor Daugaard doesn’t want to force all of those low-income parents to get jobs. He wants to target an estimated 4,500 of those recipients—less than 4% of Medicaid enrollees—who are not caring for children under age 1. He proposes pilot programs in Minnehaha and Pennington counties, where, supposedly, it should be easiest for targeted Medicaid enrollees to find work. He also mentioned offering premium support and child care to help those parents keep their jobs.
The Trump Administration has bleated some Newspeak about ending the “soft bigotry” of the social programs of the Obama Administration. Yet Governor Daugaard appears to justify his work demand with some hard assumptions of his own about Medicaid recipients:
“Work is an important part of personal fulfillment,” Daugaard said. “By making this adjustment to our Medicaid program, we can continue to help those who need it the most and start to connect those who can work with jobs that give them that sense of self-worth and accomplishment” [James Nord, “Daugaard: South Dakota Seeking Medicaid Work Requirement,” AP via McClatchy, 2018.01.09].
Daugaard here assumes that poor people between jobs lack a sense of self-worth and accomplishment. He also assumes that any old job will provide a sense of self-worth and accomplishment. Both assumptions are fallacious. There are other sources of self-worth and accomplishment. There are also jobs (especially jobs forced upon workers) that erode one’s sense of self-worth and accomplishment.
Instead of degrading the poor, South Dakota should focus on the main objective of Medicaid—making sure Americans get health care. Requiring work does not do that—after all, there are apparently thousands of South Dakotans with jobs who still get Medicaid, and there are thousands more who have jobs but can’t afford private insurance whom we could cover if we expanded Medicaid under the Affordable Care Act. The extraneity of work requirements to Medicaid’s main objective could get the Daugaard/Trump plan canned in court:
Liberal groups are preparing to sue the administration over the changes, arguing that work requirements are not allowed under current law and would require congressional action. Waivers must promote the “objectives” of Medicaid to be approved under the law, and Democrats argue a change that could cause people to lose coverage fails that standard.
“The guidance is an attempt to put the administration’s preferred legal framing around the waiver approvals, in anticipation of likely legal challenge in the federal courts,” Fishman, who now works for Families USA, a liberal advocacy group, wrote in the email. “Given that the legal standard is whether the waivers ‘promote the objectives’ of the Medicaid program, that the basic objective of the program is to cover low-income people, and that these waivers will take coverage away from low-income people, they will have a tough legal case to make” [Peter Sullivan, “Trump Poised to Take Action on Medicaid Work Requirements,” The Hill, 2018.01.05].
Instead of looking for ways to kick people out of public health coverage, South Dakota should focus on making sure every South Dakotan, men women, and children, can afford to go to the clinic or the hospital and get well. Help people get healthy and stay healthy, and they’ll feel better about themselves and about getting up and going to work.